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3460 Naglee Rd. Record ID# PR0517826 <br /> 12/7/2020 Program: HW <br /> Photo 17: The following uniform hazardous waste manifest(020607470JJK) lacking signed designated facility copy. <br /> Please pont a1 type. F—Approved.OMB No.2050-0099 <br /> UNIFORM HAZARDOUS I_Ge"eralorlDNumbar <br /> cr 2iPaa1M 3 Emgeq Rupe—Phwe CMai <br /> WASTE MANIFEST 94575.5053-INFOTRAC 0f2esE T0rac6klng/13NumbOJJ <br /> K <br /> S.Geraralor's Name and haailingAddresa � I'"� Iti - ;GererolNs SaeAddres Cd d'dlerent Na�maaing addmssl <br /> Genemfxfx Fhxrze: t .L ll <br /> 6.Tmr.",l Compare Name US.)E1,0Dmber CA100039BC19 <br /> CLF1YrffECItl EHA4ROMAENTAL <br /> - 1.Transpaner 2 Company Name u.S. rnbar <br /> S Geeylielxd Fadmy Name and aIle Address CLEANTECN ENVIROfr.IEWAL U.S. mber <br /> CALSi0033D453 <br /> 15920 NNRTM RD <br /> IRWINDALE,CA 4170606A <br /> Fedll among:9Z9-917.77D0 <br /> 9s. RI,Q,&DDTC—pdun Cmdadllq Prcper Shlppng Name,HazaN Class.lD Number, ID.Cmlamen 11. 12.Ural 13-Waste Godes <br /> HM aMPacNng GmaP(TenyY1 No. Typo OvaWVNol. <br /> I. "VRCRAK4ZARDOIdSWASTE SOLID(ABSORBENrMWERFILTE OM P 352 <br /> o MEDA) !rpN.RCRA HAZARDOUS WA67E SOLID(OILYSOLID WiLSTEIUSEO DM P 3624v4ETAL O)L FILTERS} <br /> a WA4-RCRA HA7ARDOUS WAVE SOLID(USED ABSCROWn J DM P �2 <br /> 4. <br /> 1 <br /> 14.SPedal Hwdlir:A lnsh(tib ,r And k,al Inlomration <br /> 981PROFILEY DB2)PROfILE#.... .jM3}PR0FILE* L>8E43i9VESAND0000LESTMKERm <br /> !PAPER FfETERS) (METAL FILTERS) (ABSORBENT FILTERB) - <br /> CALLER FAUST 1DETTTIFY CLEAWECN EWIROfAl1AE}FrAL AS REGRSTRANT,IT4FOTRAC 80EF43&SM <br /> 15. GENERATOR'8l4)F"GR'SCERTIFICATIDN:Iherelry declare fhn dla caMenls of Va'S consgnmerA are lolly and arrumlely dexcdhetl above of the pmper shpAlr9 trema,acid ale tla.{fed,paclsged, e <br /> malaed and laheleNplaprdad,olid are In EA respells In grope[NryJition for Nansporla'ynrdolg b appllta61e in19mafianaland national governmental 2guladorta_Ir alp=ohlpmenl end l am dre Primary <br /> Exposer,(certify Nat me mnlelsls ofIhls mnsl9-1 vadum toths*e uIthe attached EPAAa,.Madgmenlof Cnrlsenl <br /> t certify Ma!he wash mirtimzaWn statement Itlen6aed in 40 CFR 26227(x)(Al am a large quantity genemlar)or(o)(d[an a s[ae 4vana[y ganamlor)is eue. <br /> GerxmitdslDAarpls PnntedRyped Name 5fgnatwe�__-_ MOnIl1 gay Yea <br /> 16.Inkmalional 5wpmenls <br /> _ ❑Impmio U.S. ❑EFpxA Rom U.S. Palareneyfext <br /> Transporter sigmtur¢rverpolts only): Date Iearing U.S.: <br /> w 17.Transport AGT kMgmenl a Rec;O fM.Wdaix <br /> W�Tmnapwlvt l FdnledfrypM Name SgneWre - Month Bay Y¢ar <br /> a r ` f <br /> s Trersporter2Ainled/Typed Name 5lgnahrm <br /> Month gay Year <br /> r I <br /> 18.Disaeparrcy 1 <br /> Taa.Disneparxylndicagon Space ❑Quanaty DType ❑Realdua ❑ <br /> ❑Padlal Raiecdon Futl Rejection <br /> 18b.Allemale Facility(a Gen Wr) MaV.1 Relmence Number. <br /> � IIS.EPA ID Number <br /> U <br /> u Facilily's Phone: <br /> F 18c-Signalvm orAAemale <br /> Foully(a Gegermlor) <br /> 1 Month Day Year <br /> 55 19.Hazardous Waste Repod Menagemenl Method Codas(I e.,codes for trarsrdous waste Imelmenl,diaposel,end reryding systema) <br /> 4. <br /> I 20.Oesignaled FacitAy Qwnerw Operator.Certihw6on of reoatplol hvadous materials covered by the maralesl except es ntled in Item The <br /> 11V)I Prinled✓<yped Name <br /> Signature Month Day Yea. <br /> EPA Farm 870D-22(Rev.12.1, Praviaus edlb'Dns are DbsWele. <br /> GENERATOR'S INITIAL COPY <br /> JASON GAITAN, REHS Page 17 of 21 <br />